“Should We Stop Using Antipsychotic Medication?”

In a recent interview, Nancy Andreasen, former editor-in-chief of the American Journal of Psychiatry, reaffirmed her earlier findings that antipsychotics shrink brain tissue. “We spent a couple of years analyzing the data more or less hoping we had made a mistake,” she said, in an article that has been posted in PsychCentral and Science Daily. “But in the end, it was a solid finding that wasn’t going to go away, so we decided to go ahead and publish it. The impact is painful because psychiatrists, patients, and family members don’t know how to interpret this finding. ‘Should we stop using antipsychotic medication? Should we be using less?’” While concluding that antipsychotics may still be helpful, Andreasen conceded that “antipsychotic treatment has a negative impact on the brain.”

Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

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39 COMMENTS

I think we should look at not introducing people to “anitpsychotic” drugs in the first place, and try to assist those already on them to be on the least possible amount (preferably zero). Surely we will look back on these drugs in a similar way to how we now look at lobotomies and that can’t be good.

More alarming than the statement about drugs causing loss of brain tissue is the statement in the article that people with schizophrenia have less brain tissue at “first episode”, attributable to the “disease”.

Other studies that have claimed this were found to be flawed. As usual, the data is not in the article nor is it available in the publications cited so that people can figure out what she did this time.

The study does not say how many of the people never got drugs.

It appears that the number of subjects who were not given any drugs AFTER the first measure was zero. No surprise that the more medication that was given, the greater the brain changes. All the brain shrinkage could have been due to drugs, and probably was, but there is no way to tell from the information provided.

Regarding the initial differences in brain size: The study probably had no control to screen out the effects of drugs taken BEFORE the first episode/ first measure. If they were real, the differences may have been due to drugs like stimulants, which cause brain shrinkage and increase the risk of psychosis.

To the extent that the initial differences were not real, they may have related to age or body size, while Andreasen has attributed them to schizophrenia. Sometimes tiny differences are treated as significant when they clearly are not, as indicated by variation among the relevant population. That is the kind of bad science that is often offered in these type of studies.

I think that studies like this should not be posted or quoted unless we know where to go to get the raw data, which often involves uncontrolled variables, and always tells a more complicated story than the narrative.

Yes I agree that the article on one hand seems to be saying that schizophrenia exists and is because of brain damage, on the other hand too much anti-psychotics also can cause brain damage.

Although I agree that anti-psychotics and other psychiatric drugs affect brain cells I’m still not convinced that there is such a thing as schizophrenia or that even if there were that it’s caused by brain damage.

The issue is the label, the diagnosis and the psychiatric treatment. In my opinion. Having been labelled, forcibly treated and stuck in a dead end cul-de-sac of “severe and enduring mental illness”. Didn’t believe it, took charge of my own mental health and recovered.

I’m starting to think that MIA has a hear-what-you-want to hear mentality when interpreting these articles.

The summary on MIA:
Oh no, the drugs cause brain damage. We’ve more than verified it; should we stop using them?

What the article actually says;
Schizphrenia causes brain damage. The longer the relapse/psychosis the more the damage. It’s a problem that patients and family members interpret the article she published years ago as reasons to quit taking the drugs. The drugs emptied the aslyums and even though they have side effects, “they have fewer side effects than some of the other medications we use.”

You’re dead wrong. Asylum populations actually went up immediately after the introduction of antipsychotics. When they went down afterwards, there were many reasons, most of them economic. And your quote “they have fewer side effects than some of the other medications we use” sounds like it comes directly from the esteemed Dr. E. Fuller Torrey’s mouth. We don’t even know what “schizophrenia” is, never mind what it does to the body.

Francesca: As a person who has taken psychotropic drugs for twenty-five years i have decided mixed feelings about articles and subsequent postings that appear on MIA. My strongest emotion relates to the fact that opposing views were hidden from me. When I was strong armed into taking the psychotropics it was presented to me as an edict from on high. Over the last two years I have been taking two steps forward and one step back in reducing the amount of medication. I became especially concerned when the psych told me that the lithium was causing kidney damage but continued to prescribe it any way. Perhaps cursed by knowing to much, I became aware that thanks to MIA ethical psychology and psychiatry that there existed outpatient commitment laws. I had no idea what the law was in my state of WV. So I was more than a little scarred when I confronted the psychiatrist with the fait accompli of my withdraw from lithium. So as far as the science goes I would like to know more. I do wonder if I would have gained 50 pounds luckily I have lost 35. Also there is no guarantee that the lithium caused the kidney damage-I have medical records from the urologists linking low kidney function to the lithium. I guess for me, the inconvertible truth with which I can confront the psychiatric establishment is that I have been put in a situation where I am still dependent people, who by their own admission have admitted to harming me. I tried to find legal council. I did get to talk to one lawyer out of about a dozen, but since his partner was a friend from my circle of friends at my son’s school I dropped it. I am looking to leverage my situation in the public arena. Really I get the impression most of the subsideray personnel in psych hospitals are basically decent but, but the general public is entirely clueless about the implications of involuntary commitment, and history of mental illness designation. This most glaringly obvious when it comes tot the gun debate. It is earily similar to a commitment hearing where you are being talked about as if you are not in the room. I feel empowered to speak out. I believe that my list of accomplishments in the last quarter of a century leaves the psychiatric authorities in the dust. I am searching for a larger forum. I posted on Bruce levines’ site. His work appears on the counter punch website which best reflects my broader range of interests. Postings like yours are encouraging. Thank you.

You critique MIA for supposedly misreading the summary of the article.You claim that MIA readers have a “hear what you want to hear mentality.” The evidence does not support that claim. I wonder if some people have a tendency to overlook ambivalence, ambiguity and self-deception–common today among mainstream psychiatrists. Does that explain why you failed to see that Chrys’ summary right about your was correct?
Chrys wrote:”.. the article on one hand seems to be saying that schizophrenia exists and is because of brain damage, on the other hand too much anti-psychotics also can cause brain damage.” She did not hear what she wanted to hear. She got the ambivalence of the article.But all of the MIA readers above your comment got it exactly right, and made trenchant criticisms.

While you accurately summarized what the article “actually says” you inaccurately denied Andreasen’s admission.Bob explains below WHY it is important.

The summary of the article could not have been clearer: “The researchers also analyzed the effect of medication on the brain tissue. Although results were not the same for every patient, the group found that in general, the higher the anti-psychotic medication doses, the greater the loss of brain tissue.”
If you doubt your own eyes, the next sentences confirms it
“This was a very upsetting finding. We spent a couple of years analyzing the data more or less hoping we had made a mistake. But in the end, it was a solid finding that wasn’t going to go away, so we decided to go ahead and publish it.” It is revealing of the turpitude of the profession that Andreasen considered not publishing it!

Ambivalence, ambiguity,and a willingness to mislead clients–for their own good of course.
Seth Farber, Ph.D.http://www.sethHfarber.com

Nancy Andreasen is trying to make the unpalatable somehow palatable, she knows that neuroleptics, even the “atypical” ones cause brain shrinkage, animal studies prove this beyond doubt.

I am interested as to how many people in the study were actually drug free (i.e. never at any time taking neuroleptic drugs) at the time of their first MRI scans. I recall reading that people in her study had been on neuroleptics prior to the initial scans, albeit for a short period. The only way that it could be tested that “schizophrenia” causes brain shrinkage (and to what degree this may be so) is by studying people that are truly naive with respect to neuroleptic drugs.

Yes. And we’d have to actually check the facts out with the person themselves, not with the psychiatric professionals.

I believe that ‘evidence-based’ research is all about proving a certain perspective that researchers are looking for. Therefore questions will be asked to elicit the ‘proof’ that is needed to justify the stance that was taken in the first instance.

Eg proving that ECT is effective. Just ask the people for whom it is a preferred choice, who are desperate, who have tried everything else and it doesn’t work. That is, tried everything else that psychiatry has to offer. Which isn’t everything and might only be choosing between the ‘devil and the deep blue sea’, if you like.

Yes, Nancy Andreasen is still saying that schizophrenia itself is causing some decline in brain volumes. But here is the key point here, and why we ran a link to this interview: In her last publication, the one referred to here, she so completely obscured the fact that she had previoiusly found declining brain volumes associated with drug usage, that many readers of that article started discounting that association, saying Andreasen had back away from it. I hear this all the time now when I speak–oh, Andreasen no longer believes that to be so. So, from that context, that is the news here, that she acknowledges (again) the drugs do cause this shrinkage. You can see too in this article how she didn’t want to acknowledge this, or even really publish it. That is news here too.

As for the evidence that there is shrinkage associated with the “disease,” meaning that people so diagnosed have smaller brain volumes, JOnathan Leo and Joann Moncrieff did a very good job of investigating this literature, and what you find is that most of the studies that claim to be of drug naive patients (and thus report smaller brain volumes), are not in fact of drug naive patients, but in patients who have been exposed to the drugs for a brief time. IN the three studies where patients trully were drug naive, they did not show significant brain shrinkage comparable to controls.

Now, it may be that trauma and other environmental factors that may lead to psychosis and the other “symptoms” that lead to a schizophrenia diagnosis are associated with brain shrinkage. I don’t know. But the real news here, for the field, is that Andreasen is, within the article, acknowledging that the drugs shrink the brain. Maybe that isn’t “news” to many MIA readers, or those who comment here, but it would be “news” to many in the field who believe that Andreasen had backed away from her earlier findings.

Thanks for clarifying Bob. It is good to hear that Nancy Andreasen is to some extent changing her opinion, or at least being forced to admit the issues to do with psychiatric drugs and brain tissue shrinkage.

This is “good” news, IMO, because far too often we read about the harmful effects of neuroleptics on other parts of the body, ie causing diabetes.

Rarely, if ever the effects to the brain. It would be helpful if more focus was placed not only on brain loss, but how frontal cortex loss impacts thought, feeling, relationships, dare i say, the soul of an individual.

If this were brought forward, I think you would see more religious groups take a stronger interest. Not only Vatican with children (as took place this summer), but other denominations and sects, with children, youth and adults.

The *soul*. These so-called “medicines” have an effect on the journey of the soul.

This, IMO, is the largest of all issues. And it needs to be addressed by our culture.

Duane I’m with you on the topic of ‘soul’ and/or spiritual matters, in terms of psychiatric treatment.

It seems to me that it used to be the church of religion that dealt with mad people, not in a good way, and now it’s the church of psychiatry not doing any better.

However having a faith is not the same as having a religion, as I see it. And churches are institutions where there are inevitable power struggles and vying for position. I say this having been a member of churches for many a year.

So although I would like a consideration of the spiritual I wouldn’t want religion to be taking over again, from psychiatry. I’ve been involved with both institutions and neither helped me in any spiritual sense.

Thanks for your work. I look forward to reading your book when I can find a significant block of time to read and reflect upon it. In a space frm about tree to five years a ago I read about ten books by Szasz and most of the articles from ethical human psychology and psychiatry journal, also goffman
I posted on francesca’site today. I think that I am intertwining a historical and a sociological narrative in a personal way. I also think that it is crucial to link this to the science while at the same time making a political stand. For me as a person, I maintain because I see my MI label as but one part of me but at the same time something valuable that has been given to me. I am searching as to leverage it for my bebifit as well as the benefit of others. I like how Tina minkowitz and others link our struggle to the struggle of others.

I am so tired of hearing that “schizophrenics can now live in the community because of our drugs.” It’s such a lie, but Andreasen continues to publish this nonsensical myth. It was a social policy change that had nothing to do with drugs, as Bob so amply demonstrates in his book.

That being said, she is pretty mainstream, and for her to admit that there really is brain shrinkage due to neuroleptic use is very helpful.

It’s also important to remember that any links between “mental illness” and brain volume are based on average measurements. There is no direct correlation where you can say that “this person has schizophrenia and therefore will have a smaller cranial capacity.”

They continue to grasp at straws to hold up their unsupportable brain-damage theories of mental illness. But the data is now becoming clearer and clearer, and sooner or later, they will lose.

Do you (or does anybody) remember the sensational idea that “people use only 3% of the brains”? I remember it and I was offended by it.

I wonder if part of the problem for some so-called mentally ill people is that they ARE using a whole lot of their brains / minds and maybe these psych drugs are intended to bring a person down to that 3% level.

And maybe I’m being overly optimistic – I think this particular iteration of psychiatric oppression may end, if only because the profits in it are evaporating very quickly, and the hard truth of the long-term impact of psych drugs is finally getting the press it deserves. But I have no doubt that the shadow (as JRR Tolkien put it) will reform and grow in another manifestation. It’s the basic good vs. evil battle, and probably never will end. But I do think the idea that mental illness is a purely physiological issue that can be treated with drugs is on the way out. Slowly but surely, the pendulum swings back again…

Francesca: one last thought in addition to successfully confronting the psychiatrist over lithium, I am also challenging my primary care physician to hold his beliefs about psychiatry up to scrutiny, and I have openly challenged the psychiatric establishment in The Charleston gazette the state’s most widely circulated newspaper.

I think Bob hit this one on the head. Nancy was THE authority in the so-called ‘Decade of the Brain” her books, The Broken Brain and Brave New Brain were pointed to as “evidence” of the biological underpinnings of so-called mental illness. Her acknowledgement, however grudging, that the drugs cause brain shrinkage (aka Damage) is a big deal because of pedestal she’s been raised to by those espousing the bio-reducio-absurdum view.
D

This statement in the article (see below) appears to say that there’s something wrong with the brain before the first psychotic episode.

“Lack of brain tissue found in schizophrenic patients

‘Scans from the patients’ first episode revealed that they had less brain tissue, compared with healthy individuals without the disorder.

“The researchers say this finding suggests that something is affecting the brains of those with schizophrenia before they demonstrate obvious symptoms of the conditions.”

Dr Andreasen implies that though meds cause damage to the brain, they may be caused by “pregnancy complications or exposure to viruses”. What about trauma in childhood? Perry has proven that trauma in children lasts long after the traumatic incidence(s) and others (eg Heim) have shown the persistence of psychological and neurodevelopmental conditions.(Read, Perry et al comment “As is often the case, women with a history of psychosis were not included in Heim’s study.’)

The neglect of trauma in the causation of psychosis is extraordinary, given its prevalence in the inpatient histories of people with psychosis. Why is it being ignored by researchers? Read et al again: “In the last four decades (60s-90s), for every study on the relationship between child abuse/neglect and schizophrenia, there have been 30 on the biochemistry of schizophrenia and 46 on the genetics.”

I applaud Dr Andreasen’s concerns around the use of antipsychotic medications. However, trauma is “the elephant in the room” which is still invisible in mainstream psychiatry.

Great post! I would add that it is fascinating that psychiatry focuses vast amounts of energy on genetics, which is the one variable we CAN’T change. Why not focus on the environment, which is a variable under our control? The 1:76 ratio of scientific studies really reinforces the intentional blindness of the “profession” to this weird bias. In underscores my view (and many others’) that psychiatry is a religion, not a scientific medical practice.

Actually, there is information that genes can be changed. According to Bruce Lipton, a cell biologist, says that genes are environment dependent and can be changed.

“His research at Stanford University’s School of Medicine, between 1987 and 1992, revealed that the environment, operating though the membrane, controlled the behavior and physiology of the cell, turning genes on and off. His discoveries, which ran counter to the established scientific view that life is controlled by the genes, presaged one of today’s most important fields of study, the science of epigenetics.”

From this presentation, he says 500 genes changed their function in people who spent 90 days of making changes to their diet and developing stress management and meditation. It’s worth the full listen (just over an hour long) but the point about 500 genes changing starts at about 0:12:08

Which reinforces my point – even the function of the genes themselves is changed by changes in the environment and our own decisions! We inherit whatever genetic material we inherit, and there’s not a damned thing we can do about it, but how those genes are EXPRESSED is something we have a massive amount of control over. Which means we also control our brain chemistry to a huge extent, and apparently can even cause new neurons to grow through meditation!

So why is all the money being spent on studying genes and brain chemistry? Why not spend the money on preventing trauma, learning good living habits, and finding techniques to assist those who have been traumatized to re-establish control over their own bodies and brains?

Rhetorical question. We know the answers, of course. There is no money in helping people become independent and highly functioning, and acknowledging the role of trauma, poverty and abuse in mental illness means those in power have to take some accountability for their own behavior. Much easier and more comfortable to blame the brain!

I think it also underscores the great reluctance on the part of many people, especially many psychiatrists, to admit that children are being traumatized right and left in this society. They just don’t want to deal wiht it.

The Adverse Childhood Experiences Study pointed this out very clearly. When you read stats like one in four girls and one in six boys are sexually abused in this county it should stop and make one take notice. This study points out that at least 70% of people here in the United States are trauma survivors and 80% of people held in psychiatric facilities have been traumatized in their lives. But we do nothing about it and many psychiatrists try to suppress any talk about it. In fact, most of them just don’t bother to talk with people at all about their lives. I’ve dealt directly with four psychiatrists in my “journey” through the supposed “mental health system. Of those four, one and one only, was willing to sit down and listen to my story and then work from there to find ways, other than the toxic drugs, to find healing and well-being for me. And he was a young intern! The attending psychiatrist told him to be sure that he (the intern) didn’t let me know that he didn’t know everything! the intern told me this and I laughed and said, “But you know, that I know, that you don’t know everything! Am I supposed to be ignorant or stupid or both???” We both had a good laugh about this. But he was young and an intern.

Dr. Michael Anda was one of the people involved in the collection of the ACE study data and he stated:
“But our society has tended to treat the abuse, maltreatment, violence and chaotic experiences of our children as an oddity instead of commonplace, as the ACE Study revealed.”

Right on Stephen!
We’re bringing Dr. Felitti in for some training in April. We’ve been laying the groundwork with our community for some time now about the importance of trauma, particularly trauma in childhood. Future Blog in the works!